Proprioceptive Neuromuscular Facilitation combined with electrical stimulation for facial palsy after total parotidectomy: a case report.

BACKGROUND

Transient facial nerve (FN) paralysis occurs in 15%-66% of cases following parotid surgery. These high numbers of postoperative facial palsy raise concerns about the integrity of the seventh cranial nerve. This report evaluates the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) combined with electrical stimulation (ES) for post-parotidectomy facial palsy.

CASE PRESENTATION: A 57-year-old male presented with severe facial paralysis (House-Brackmann [HB] Grade IV) following a left total parotidectomy for basal cell adenocarcinoma in 2024. Baseline Facial Disability Index (FDI) scores were 44/100 (physical function) and 64/100 (social/well-being).

INTERVENTIONS: The patient underwent 12 sessions over 6 weeks. Treatment included PNF techniques and Faradic current (FC). The FC was applied for 20 min per session using a frequency of 50 Hz and a pulse duration of 12 s with a duty cycle of 1:1.

OUTCOMES: The patient demonstrated significant recovery. The eyes' closure was complete. Facial symmetry and well-defined facial expressions were observed after treatment. The patient reported improvements in mood and overall mental well-being. The FDI score showed very effective recovery, with scores of 93/100 for physical function and 94/100 for social/well-being. Post-treatment HB scale indicates (Grade II) a mild weakness in the platysma muscle, which is innervated by the cervical branch.

CONCLUSION

In this single case, PNF combined with FC was associated with significant functional recovery of facial palsy following total parotidectomy. However, this protocol proved insufficient in fully resolving the long-term potential chronic sequelae, specifically cervical branch weakness, necessitating larger controlled trials to establish efficacy.